Public Mood on COVID-19 Vaccine Resistance

"We've had discussions at the task force, we've had presentations by experts in this area, about vaccine hesitancy. It's not the extreme anti-vaxxers we're talking about -- it's people who I think quite reasonably will have an 'I'll wait a little bit and see what my friends say', kind of thing." 

"And I would say, in a word, this comes down to trust. A lot of people have been concerned because it [vaccine trials] seems to be going so fast."

"The honest answer is, we don't know [what vaccine uptake numbers should be to achieve herd immunity]. Obviously, the higher the number, the better."

"It would be unwise to say, 'Gee there won't be any side effects'. We don't know that. We just don't know the answer to that question until we do the Phase III  trials."

"[But] one has to remember we're in the middle of a pandemic. So you have to weigh -- we all have to weigh -- the risks of taking a vaccine against the risk of getting COVID."

"[And unlike in the U.S.], there is no evidence whatsoever of political interference, or any other kind of compromising, on safety. So I think we're quite lucky in this country that we can trust our regulator."

"Public health is all about transparency communication, earning the public's trust. This [eventual vaccine] will not necessarily be a magic bullet. It'll be part of the public health armamentarium; wearing a mask, washing our hands, keep a distance, and the vaccine."

"We will eventually get rid of this virus. But it won't happen the day after you are immunized."

Dr.Alan Bernstein, COVID-19 vaccine task force Canada

"[While most vaccine safety scares aren't supported by scientific evidence], without substantial global investment in active vaccine safety surveillance, continuous monitoring of public perceptions and development of rapid and flexible communication strategies, there is a risk of SARS-CoV-2 vaccine never reaching their potential due to a continued inability to quickly and effectively respond to public vaccine safety concerns, real or otherwise."

Institute for Vaccine Safety, Johns Hopkins Bloomberg School of Public Health

Research assistant Jae-Heon Kim conducts research on a vaccine for the novel coronavirus at a laboratory in San Diego, California, March 17, 2020   Photo by Bing Guan/Reuters

The World Economic Forum had contracted with Ipsos to conduct a survey, released in August, of 20,000 adults from 27 countries, which found that 74 percent of the polled would opt for an inoculation against COVID, but 37 percent only agreed strongly, while 37 percent somewhat agreed. In most countries, the pollsters reported, the agreeable group vastly outnumbered the group choosing to disagree. Last year, the World Health Organization identified vaccine hesitancy as one of the top ten global health threats.

 

Critics contend that U.S.President Donald Trump has politicized the issue of COVID-19 vaccines, and in so doing has seriously undermined public confidence. He has stated that his administration may -- or may not -- approve more stringent FDA standards linked to emergency authorization of a COVID vaccine. "Because when you have Pfizer, Johnson and Johnson, Moderna, these great companies, coming up with the vaccines and they've done testing and everything else ... why would they have to be adding great length to the process?", Mr.Trump has mused. 

A number of the front-runner candidates for vaccines are RNA-based vaccines, using specific parts f the SARS-CoV-2 virus genetic code meant to trigger an immune response. This is an entirely different process. Normally to develop a new vaccine it will take a decade and more. And in the current situation with the global pandemic, researchers and pharmaceutical labs are attempting to do the research, the trials, due diligence in one year; collapsing ten into one.  Even so, emphasizes Dr.Bernstein, president and CEO of the global research organization CIFAR, there are no short-cuts being taken.

 

Anti-vaccine demonstrators outside the Centers for Disease Control and Prevention in Atlanta in June. Credit...Audra Melton for The New York Times

Physicist Neil Johnson of George Washington University has been tracking online vaccine conversations through 100 million Facebook users, noting that pre-COVID the "undecided" were becoming more tangled up with hard-core anti-vaxxers, a trend that has strengthened since March. That the science keeps shifting, and evolving appears to be part of the problem in public perception. Questions such as whether or not COVID is airborne, what the size is of a particle, a droplet; "Should you be six feet away, should it be three feet, should it be 2,000?", queries Dr.Johnson. "It's not wrong, it just looks like science doesn't know."

And Dr.Johnson identifies safety, need, big-pharma conspiracies and does-science-actually-know-what-it's-doing, as the major impact appearing among the "not-sures". "But we also see it -- and I think this is even more scary -- in the yeses, the ones that say 'they would get a vaccine', who then inside are thinking, 'yeah, but I wouldn't be first in line. I'm going to wait until my whole street, everybody I know has it, and if they're still standing a few months later, I'll get one."

Question: What happens if you have the flu shot at the same time as the first COVID shot? What happens if I've had antibodies already established in me and I have the vaccine, is that bad? "These are the things occurring to them." It's not yet clear which strategy will be the most effective among the dozens of vaccines now being tested in humans, though the best vaccines are those most clearly mimicking a natural infection; avoiding making the person sick, even killing them.

Even a partially effective vaccine in the 60- to 70-percent range would produce an important impact; on the other hand the less effective the vaccine turns out, the greater the number of people required to be vaccinated to achieve herd immunity. Another unknown: how long vaccine-induced immunity may be good for; months? a year? longer? What is anticipated is that the vaccines would be more effective in the young and the healthy, and far less so among the health-impaired and the elderly.

"[The choice whether to be vaccinated is one most people won't have to face for months], if not a year or more. The supply just won't be there for the general public."

"[Despite the prospect of a potentially fearsome fall and winter surge of COVID, and the potential that vaccines] can liberate everyone from the constraints on liberty [represented by lockdowns and quarantining, there are some people who will say] count me out."

"They don't trust vaccines or they don't trust the government to provide a safe one."

Arthur Caplan, founding head, division of medical ethics, NYU School of Medicine

Flushing and Disinfecting Texas Area Water Supply of Brain-Destroying Amoebas

Naegleria fowleri

"The state of Texas is taking swift action to respond to the situation and support the communities whose water systems have been impacted by this amoeba."

"I urge Texans in Lake Jackson to follow the guidance of local officials and take the appropriate precautions to protect their health and safety as we work to restore safe tap water in the community."

Texas Governor Greg Abbott, Brazoria County disaster declaration 

"During this period of disinfection and flushing boiling the tap water makes it safe for drinking and cooking."

"Naegleria fowleri is a type of amoeba that can be managed using standard treatment and disinfection processes."

Texas Commission on Environmental Quality advisory

 

"The path forward for the citizens of Lake Jackson is not going to be one that's short."

"We have to get through the boil water first, which could take two to three weeks, after that we have to get chlorine levels to a state that can burn the entire system, scour the system, and kill the amoebas."

"That could take up to an additional 60 days." 

Toby Baker, executive director, Texas Commission on Environmental Quality 

It takes a tragedy, a death of one small boy to alert a community that something is dreadfully wrong with their potable water supply, the most fundamental of services to any community. One might assume that regular water quality tests are carried out constantly to alert authorities of the presence of deadly bacteria that could have an unwanted and horrible effect on the people dependent on the safety of their municipal water supply.

 

Josiah McIntyre.  (Courtesy of Maria Castillo via AP)

But the discovery that something was dreadfully awry with the water purity of people living in Lake Jackson, Texas was brought to the attention of the water treatment arm of the local government by the death of a small boy. Six-year-old Josiah McIntyre, a resident of Lake Jackson, contracted the deadly microbe and it killed him. Leading local authorities and the Centers for Disease Control and Prevention to test the local water, with preliminary results affirming three in 11 samples testing positive for the presence of Naegleria fowleri.

 

This is an amoeba that destroys brain tissue, leading to swelling of the brain, known as amoebic meningoencephalitis. The amoeba is frequently discovered within warm lakes, rivers and hot springs. The mode of infection sees the nose as the portal allowing the pathogen to enter the body and reach the brain where it destroys tissue, causes brain swelling, and ultimately death.

One of the samples tested was from a hose spigot at the boy's home. "The notification to us at that time was that he had played at one of [the] play fountains and he may have also played with a water hose at the home", explained Lake Jackson City Manager Modesto Mundo. A 'do-not-use' advisory was issued on Friday night by the Brazosport Water Authority, for eight communities, following confirmation of the presence of the amoeba.

People were urged to avoid having water reaching and inhaled by the nose when bathing, showering or swimming, and prohibited children from playing with water hoses, sprinklers or any device capable of squirting water up the nose. The community residents were advised to run bath and shower taps and hoses for several minutes initial to use. Tap water was to be boiled prior to drinking it.

City workers test water flowing out of a hydrants.  (AP Photo/Jim Mone)

City workers were tasked with converting the disinfectant from chloramine to free chlorine in the distribution system; a practice called "chlorine burn", useful in inactivating certain types of bacteria whose presence can make it difficult to maintain a disinfectant residual. City officials distributed water boxes to the population of 27,000 at a temporary distribution centre.

Initial symptoms of the dread disease include headache, fever, vomiting, loss of balance and hallucinations, which can lead to death within a five-day span. Infections, while rare, can be devastating since this is a fatal microbe. In the United States since 1962, 145 infections were reported, out of which a mere four people survived, according to the Centers for Disease Control and Prevention.

Exercise Therapy Protocols for Chronic Back Pain

Exercise helps back pain, but not all exercise is equal. Credit:Getty

"There was evidence that Pilates and stabilization or motor control exercise training were the best of these exercises for reducing pain."

"The least likely treatments to be effective included hands-off treatment, such as only educating people about chronic pain or doing psychological interventions alone, and hands-on treatment, like manual therapy, massage and acupuncture."

"Importantly, stretching and McKenzie exercises, which is a treatment approach that uses a classification system to prescribe exercise, were found to be the least effective kinds of exercises."

"Low back pain affects 80 to 90 per cent of Australians in their lifetime and while the majority of spinal pain cases resolve without specific intervention, it's chronic or persistent low back pain that presents the greatest challenge."

"In the vast majority of chronic low back pain cases the pain is 'non-specific' meaning that clinicians cannot define a specific diagnosis, or cause, of the pain."

"There is a common misconception that if someone is in pain, they should be resting, but our research shows that when the pain has been there for a long time, exercise is an important part of treatment."

"Active exercise where the person is taken though a structured program to regain confidence with their body and movement can help reduce pain."

Associate Professor Daniel Belavy, Deakin University, Australia

Exercise can provide relief for lower back pain and be a preventive measure too.   (Supplied: Lissanthea Taylor)

Conventionally, people experiencing back pain tend to depend on home remedies such as bed rest, over-the-counter pain relievers and heat or cold compresses. Massages have their place in the gentle treatment of back pain as well. Evidence is mounting that pampering that sore back is not quite the solution. There is nothing particularly new in the message that exercise will relieve chronic back pain, but most people have a tendency to avoid exercise in the thought that it will serve to exacerbate, not help, back pain. 

Increasingly, health care professionals are steering their back-pain patients in the direction of exercise to relieve their symptoms. The kind of activities recommended, however, tend to be in the direction of  yoga and Pilates for back pain that persists. The impression is that gentle exercise is preferable to high-energy engagements such as weight training or interval workouts. Physical activity, however, tailored to the individual in the sense that their choice generally reflects the type that succeeds in relieving pain, is an integral part of any back pain therapy.

 

When Dr.Belavy and his colleagues set out to conduct their own research into exercise as therapy for back pain they decided to study the science relating to the effectiveness of types of exercise to treat chronic back pain and to that end their review looked at 89 studies with 9,543 subjects aged between 20 to 70 who rated how effective in reliving back pain specific exercise types turned out for them. They also took into account improved physical function, mental health and core strength.

 

Exercises that included strength training, Pilates, yoga, core training, cardiovascular conditioning and water-based training such as aqua fitness and stretching were all covered in their study. All those they looked at included a control group comprised of non-exercisers or subjects who had been given treatment from a physiotherapist, osteopath, chiropractor, massage therapist, or acupuncturist. Once the data was reviewed, the researchers reached the conclusion that while physical activity is indeed effective in the reduction of chronic low-back pain, no specific exercise was identified as superior to another.

 

Those who suffer persistent low back pain are instead encouraged to experiment, trying out as many exercise routines as they find useful until such time that they discover one in particular that appears to give them the optimum improvement. "Our study provided evidence that various exercise training approaches are effective and should be incorporated into usual care for adults with non-specific chronic lower back pain due to its potential for improving pain physical function, muscle strength and mental health", wrote the researchers published in the British Journal of Sports Medicine. 

"Active therapies" such as Pilates, weight training, core stabilization exercise and aerobic conditioning appeared to the researchers as most appealing where the individual is "guided (and) actively encouraged to move and exercise in a progressive fashion". Once a training regimen is established including weight training, core stabilization training, yoga, Pilates, water-based training and/or cardiovascular conditioning, physical function appeared to see the most profound improvement. 

As for the most effective exercise options in the improvement of mental health, cardiovascular conditioning and weight-training were singled out as the best choices.

 

Ignominious Awards for 'Special' or Specious Research

"[The Ig Nobel Prizes are] intended to celebrate the unusual, honour the imaginative and spur people's interest in science, medicine, and technology."

Annals of Improbable Research

Ig Nobel Prize Winner Dr. Elena Bodnar demonstrates her invention (a brassiere that can quickly convert into a pair of protective face masks) assisted by Nobel laureates Wolfgang Ketterle (left), Orhan Pamuk, and Paul Krugman (right). Photo credit: Alexey Eliseev, 2009 Ig Nobel Ceremony

"We were looking at whether or not we could detect narcissism from the face. And once we found out that people are able to do that, the next obvious question that comes up is what is it about the face? And that led us to eyebrows."

"All publicity is good publicity. This is a fun award and I like the idea behind it, that it's about research that makes you laugh but then makes you think. Because just because research is funny doesn't mean it wasn't done well. All the research that was done was published in peer-reviewed journals."

"At the end of the day, it's an honour and a fun thing to be involved in. It's got a lot of attention, most of it positive, I think. Stephen Colbert just had it on his YouTube channel, so that was fun."

Miranda Giacomin, psychology researcher

All in good fun, and a snigger or two, as people  take in their breath and mutter 'and how much funding went into this research?!'. 'They did what?!' Since 1991 the Ig Nobel awards selectively honoured research and the researchers responsible for research that made not only the public that might have heard or read about it, but other researchers do a double take. Studies into subject matter so seemingly insignificant, offbeat and at times ludicrous that they elicited incredulity and laughter.

 

This year's choices certainly fall into all the categories that most people would think of as utterly useless, a waste of time and money and an indication of mindless scrutiny into absurd topics, the results of which fail to make the world a better place. On the other hand, there is the motivation of the researchers to consider; they, after all, felt curious and felt a subject matter worth the time and effort and managed to persuade some funding body to support their research and some respected journals to publish their conclusions. 

Ten Ig Nobel prizes were distributed last week at what was titled the 30th First Annual Ig Nobel Prize Ceremony. As a result of the viral reality of SARS-CoV-2, a ceremony held virtually. With the added distinction and star power of Nobel Prize laureates making the presentations. 2007 Economics Nobel Prize-winner Eric Maskin, for example, contributed his presence and his gravitas to the ceremony by making the presentation to assistant professor Miranda Giacomin and her colleague Nicholas Rule; post-doctoral student and professor respectively, from MacEwan University in Edmonton's psychology department.

 

The distinguished winners of the Ig Nobels for 2020 were presented with a pdf file of a constructible paper cube, a certificate, and a counterfeit Zimbabwean $10-trillion bill (reflecting that country's 5 billion percent inflation rate under former President Robert Mugabe's misrule). And then there are the categories and the champions representing Acoustics, Economics, Entomology, Management, Materials Science, Medical Education, Medicine, Peace and Physics. A fairly comprehensive list of categories.

 Chinese alligators placed in helium chambers earned authors a 2020 Ig Nobel Prize.

Gregory G. Dimijian/Science Source

Alphabetically, Acoustics researchers drew their prize for having induced a Chinese alligator of female persuasion to bellow within an airtight chamber of helium-enriched air in their search to understand the medium of communication of extinct Archosaurians. Imaginative, no? While a study by researchers representing ten countries looking to quantify the relationship between national income inequality of various countries with the average number of mouth-to-mouth kisses in both, swept the Economics award category.

In a no-contest win for Entomology, an American researcher was acknowledged the winner with his study affirming that many entomologists are fearful of spiders; arachnophobia lives in the hearts and minds of insect biologists; women needn't feel squeamish about their lack of enthusiasm for spiders. In a bit of a diversion from Management researchers to hit men, five of them in China won the prize for subcontracting a murder contract and passing the job along with diminishing payouts, for a job that was never completed.

The prize for Materials Science saw no contenders that could quite match the fanciful research that researchers from the U.S. and U.K. embarked upon when they proved that knives produced from frozen human feces failed to work for their intended task. Leaders in nine countries jointly shared the prize in Medical Education, including U.S. President Donald Trump, Jair Bolsonaro of Brazil, Britain's Boris Johnson and Russia's Vladimir Putin for their brilliant "use[ing] the COVID 19 viral pandemic to teach the world that politicians can have a more immediate effect on life and death than scientists and doctors can."

And then there were the researchers who diagnosed misophonia, the medical condition reflected by distress caused when hearing other people produce chewing sounds, earning recognition through the Medicine award. The governments of India and Pakistan rated number one spot for Peace after reports that both countries' diplomats engaged in surreptitiously ringing each other's doorbells then racing off in the middle of the night. Finally, the prize for Physics was earned by two researchers in their determination of what occurs to the shape of a living earthworm when high frequency is used to vibrate the creature.

Dr Ivan Maksymov and Andrey Pototsky from Swinburne University in Melbourne took out the 2020 Ig Nobel Prize for Physics with the help of an inebriated earthworm

ARC Centre of Excellence for Nanoscale BioPhotonics, Swinburne University of Technology

Discovering The Perfect Match

"It was pretty shocking, actually. I had never seen a dog with a cleft lip before."

"The dog [puppy] has been fantastic. She even stands up to our big [family] dog."

"He [his infant son] won't feel like he's alone on this journey [through early life together]."

Brandon Boyers, farmer, Jackson, Michigan

Bentley Boyers, 2, Puppy Lacey

"I immediately told him to adopt her. I said to bring her home today."

"They [the puppy and her two-year-old son] were head over heels for each other right away. Everyone started crying."

"I found out he [her son] was going to have a cleft lip during my gender ultrasound. He had his first surgery when he was five months old. He is the strongest little boy I know."

"He knows that the dog has the same condition as he does. He understands. It so remarkable to see him share something in common with the puppy."

"Bentley spends all day playing with her. They play outside with balls and find sticks and rocks. And all three of them take a daily nap on the dog bed together."

Ashley Boyers, 23, mother of two-year-old Bentley

"I explained that they could take the puppy home two days later, after she had her final vet appointment."

"We [staff at the animal shelter] were all in tears seeing the two of them together. The fact that this is something we never see, the puppy came from a thousand miles away and that Bentley's dad just happened to be here at that moment, it was just amazing."

"The puppy immediately started soaking up all his love. It was genuine joy. She was one of the last ones of the 25 to be adopted."

Lydia Sattler, director, Jackson County Animal Shelter

Bentley Boyers, 2, is seen kissing his newly adopted rescue puppy, Lacey, on Sept. 4, 2020 at Jackson County Animal Shelter in Jackson County, Michigan. Both Bentley and Lacey were born with a cleft lip.

The U.S. Centers for Disease Control and Prevention states that approximately one in 2,800 babies in the United States is born with a cleft lip. A little boy, now two years of age, was born to two young parents in their 20s, living in Jackson, Michigan with a cleft lip. A child that has already at his tender age, experienced surgical operations to correct his condition, with more yet to come. Even at his young age, the little boy appears to know that there is something 'different' about him. It is a difference he now shares with a female, rescue puppy that has joined his household.

It isn't known how prevalent cleft lips are among dogs, but evidently purebreds experience a higher incidence rate than do mixed-breed dogs. The mixed pedigree of this puppy that little Bentley now knows as Lacey, his very own dog companion, can only be guessed at. The shelter that received the puppy feels her ancestry is manifold, reflecting many dog breeds. All of which should, in fact, result in genetic vigour. She will likely grow to canine adulthood as a sturdily healthy dog, even as the little boy grows into his own maturity.

The Jackson County Animal Shelter had a recent visitor, a man who entered in the hope that rescued chickens could be had, to help the expansion of his family's small farm. In the event, 27-year-old Brandon Boyers discovered that the chickens had already been adopted. But the chickens and his mission to acquire them escaped his mind when he looked incredulously at a puppy up for adoption, with a recognizable condition; a split lip, just like his son Bentley.

The presence of the little black-and-white puppy spurred him to call his wife. Who responded by asking her husband to adopt the puppy on the spot, and bring her home with him. Both parents were immediately struck with the thought that the puppy would make a perfect companion for their child. Because the director of the shelter advised that another vet appointment had first to take place, and then they could bring the puppy home with them they were anxious for their son to see the new friend that would soon be joining him at home.

Bentley Boyers, 2, holding his newly adopted rescue puppy, Lacey

The following day Ashley Boyers brought her son Bentley for a visit to the shelter. Bentley made directly for the puppy, cradling the little creature in his arms, then settled down next to her, a natural and loving reaction between the two was sparked, and the witnessing staff became emotional. They had never before sheltered a dog with a cleft lip. The puppy had come to their facility from Mississippi which had been overwhelmed with too many dogs in need. There were 25 dogs in all, and all went to new homes in short order, leaving Lacey unclaimed.

Bentley has already undergone two surgeries. Several additional procedures are planned for the future, among them a bone-grafting operation. The abnormality with which he was born will be corrected by surgery, and as far as the future condition of Lacey, there is confidence that the puppy will go on to enjoy a healthy, normal lifespan. The coincidence of the split lip in both the little boy and the puppy and the chance encounter by the father to discover the presence of the puppy was heart-warming to all concerned.

As expected, Lacey is adjusting with ease to her new home. A home which comes complete with another, older canine, a nine-month-old English mastiff, named Remi.

Bentley Boyers, 2, is seen with his puppy Lacey and English Mastiff, Remi.

"It's so hard to put into words how meaningful this adoption is to all of us. Bentley found his match today in this tiny pup who also has a cleft lip. They instantly loved each other", read a Facebook post written by the shelter.

"That's Not The Way It Works"

"It's a love-hate relationship [use of the phrase 'second wave'] with epidemiologists and modellers. I don't like to use the term myself -- but I find myself using it. It's so easy to go to."

"We didn't have to have a second wave. There's not a second wave in Manhattan. There isn't a second wave in New Zealand. There isn't a second wave in China."

"It  didn't sweep through the community because we were able to stop it. But now we've let off, and it's coming back."

"Businesses have been doing great. It's not the businesses that are going to shut things down. It's the other stuff. Because we haven't been able to maintain physical distancing in our social situations."

"As the cases get higher we're going to lose one of our most effective interventions for control: testing and contact tracing."

Dr.Doug Manuel, professor, School of Epidemiology and Public Health, The Ottawa Hospital

"The reason we don't talk about waves is that it implies there is something innate about the disease that  makes it cyclical. And it isn't."

"The reason it goes up and down is because human behaviour goes up and down. If you say we're in a second wave, people will think they just have to wait it out and the wave will diminish on its own. That's not the way it works."

"This [the rise in number of COVID cases] is pretty much 100 per cent driven by human behaviour,"

"The disease never went away, it's always been in certain people even during the summer when the numbers were low. It's just that the transmission rate went down because people were [not] congregating closely enough to be infected."

"Now we're congregating again, schools are opening, people are going to parties, it's cold, we're huddling inside a bit more and as a result the opportunity for transmission is happening and that results in more infections."

Dr.Raywat Deonandan, epidemiologist, associate professor, University of Ottawa

People walk, ride bikes and inline skate along Queen Elizabeth Driveway in Ottawa on May 3. (Justin Tang/Canadian Press)

 

The 'second wave' of infections of the SARS-CoV-2 virus that causes COVID-19 is driven -- quite simply -- by community transmission when extended families decide to have a gathering, at private parties, at funerals and at weddings; in short, important events in peoples' lives that they consider sufficiently vital to relax common sense and the rules that it supports during this time of a global pandemic that has swept the emotional longing for family contact off the immediate-attention shelf onto a back shelf of 'in good time' -- and this is not a good time.

Canada has managed -- against its best and most fervent wishes to avoid it -- to arrive at the milestone of 150,000 cases, and with those cases came over 9,200 deaths from COVID. There is no comfort to be had in these numbers. Canada is placed away back in ratings of COVID control, with its 3,900 cases and 244 deaths per million. The country ranks 17th and 25th in respective order in those two key areas among the 37 OECD countries; nothing whatever to brag about. Canada's central government set a poor example for its citizens when it decided to wind down threat-monitoring of COVID months earlier.

 

And the federal government's generosity in deciding early on to ship off huge amounts of PPE to China, shrugging off the idea of risks related to the pandemic in Canada, while downplaying the need to close borders, much less  wear masks, all of which produced a national set-back, while setting a poor example for citizens at large. When Canadian health authorities finally came around to changing their minds on masks and social distancing, people for the most part, complied as the case numbers rose and hospitals were in a frenzy of anticipation whether they could cope with a massive influx of seriously COVID-impacted patients.

 

Summer offered a respite when cases dwindled and heads of government and health agencies relaxed the rules. But the basics like social isolation but for a select 'bubble', and face masking in indoor spaces were to be maintained as a cautionary measure. The public, particularly those in their teens to 40s, chafed at the interruption of their social lives and that's when the infection rates began climbing again, and the 'second wave' speculation commenced, adducing the growing cases to the virus alone, bypassing the responsibility of those who surrendered theirs.

 

When infections rose in France and Spain in mid-August, epidemiologists linked that to increased socialization caused by people dropping their guard against COVID transmission. The Ottawa region and the province itself are poised to repeat the resurgence of COVID infections seen by France and Spain. Ottawa Public Health had reported many days in the summer months with no infections occurring -- until the numbers began to steadily rise; slowly then accelerating, from 40 to 60 to 90 daily. 

The city, warned its medical officer of health, Dr.Vera Etches, was nearing the "red zone", causing her to invoke the Health Protection Act imposing fines on those failing to self isolate. Ottawa Public Health mere days earlier had traced the source of dozens of infections to a social event that ultimately was responsible for the closure of two daycares and of placing ten people in hospital. The spread of this upward trend is rapid enough to make contact tracing and testing a real problem for public health.

The situation in contact tracing has gone from a positive case involving on average two close contacts early in the pandemic to the current situation where instead of being able to make contact with 98 percent of contacts within a 24-hour period, each positive case averages over five close contacts with public health nurses now able to reach fewer than 60 percent within 24 hours. Dr.Deonandan warns that deaths are set to rise, given the younger demographic between 20 to 40 years of age who represent most of the new cases and who pass the virus to older, more vulnerable people.

"Deaths are a lagging indicator. We won't see the deaths for another two weeks", he cautioned. "Really, the message is just, 'Don't socialize'. It sounds horrible, but  you've got to fight that urge. We talk about waves, people expect something innate to be part of the virus, like a fall seasonal pattern. And as well, you figure you wait out the wave, you ride the wave until it's over. That's not how it works."

 

Covid Testing

 

"The numbers go down because we did something. We went inside, we distanced, we wore masks. The numbers are going up again because we're out again and we're not following the protocols as closely as we could or should and they will continue to go up until we do something else."

SARS-CoV-2 Steadily Mutating ... Good or Bad?

"We have given this virus a lot of chances [to mutate, given its wide spread in the population]."

"There is a huge population size out there right now [for the virus to infect and replicate and make errors in its replication, thus mutating]."

James Musser, Houston Methodist Hospital, Texas

 

"Wearing masks, washing our hands, all those things are barriers to transmissibility, or contagion, but as the virus becomes more contagious it statistically is better at getting around those barriers."

"Although we don't know yet, it is well within the realm of possibility that this coronavirus, when our population-level immunity gets high enough, this coronavirus will find a way to get around our immunity. If that happened, we'd be in the same situation as with flu."

"We'll have to chase the virus and, as it mutates, we'll have to tinker with our vaccine."

David Morens, virologist, National Institute of Allergy and Infectious Diseases 

Influenza's seasonal return and medical science's efforts to suss out each return's particulars to invest each season's new vaccine as closely as possible with the ever-mutating virus's genetic code that is the current season's flu strain represents a case study in  reproduction errors and changing characteristics and properties of a virus in flux. We can immunize ourselves to the best of our scientific abilities in devising a 'correct-as-possible' formula, but we are not able to vanquish the virus to the point of disappearance. We live with it as best we can. And with each return there are virus-vulnerable casualties.

 

In Houston, scientists have released the results of a recent study where over 5,000 genetic sequences of the coronavirus were studied, revealing the virus's constant accumulation of mutations. The scientific investigators posit that one of those mutations may have produced a more contagious virus, one associated with a steeper viral load among patients at their initial diagnosis. Not yet peer-reviewed, the study was posted n the preprint server MedRxiv.

Another, larger batch of sequences was recently published by scientists in the United Kingdom, concluding that a mutation that alters the structure of the "spike protein" on the surface of the virus (which enables it to 'catch' onto a cell of the person it has invaded) could be responsible for the huge spread of that strain of the virus ... a conclusion similar to the one in the Houston study. The saving grace is that the study failed o find that the virus was deadlier.

 A health worker collects swab samples SOPA Images/LightRocket 

Viruses are known to acquire genetic mutations, most of which lack significance, and coronaviruses like SARS-CoV-2, causing COVID-19 disease happen to be quite stable, with their own 'proofreading' mechanisms in quality control, while they replicate. Still, each time a mutation takes place, the consequences are random. The opportunity for mutations to occur rise with the volume of people infected. Given the huge numbers of American cases, this avidly-replicating virus has had ample opportunities to mutate.

And the more it does, the more likely it may be for it to eventually mutate toward picking up more seriously-impacting consequences, which is what most concerns medical science. On the other hand, Dr.Musser of Houston Methodist cautions "you don't want to over-interpret what this means" though the virus changes "may have implications for our ability to control it". The virus, he explains, might be placed under selective pressure in evading the human immune response as people gain immunity through a vaccine.

Scientists at Houston Methodist have been sequencing the 30,000-character genome of the coronavirus since March, at the first appearance of the virus in the city, resulting in the documentation of 5,085 sequences. Moving in two waves through Houston neighbourhoods, striking the wealthiest and older groups first, it then moved into its second wave to infect a younger demographic and lower-income neighbourhoods with majority Latino residents.

Another clue surfacing to its infectious nature; it is the wealthy who tend to travel abroad most, bringing the virus back with them. The virus arrived initially by air travel, leading to 71 percent of the viruses that first arrived characterized by a mutation surfacing in China, giving the virus a biological advantage in the manner of its spread. By the second Houston outbreak, this variant had risen to 99.9 percent prevalence, almost completely dominating the outbreak. Truly, a Chinese virus.

The U.K.'s even larger study of the coronavirus spread was based on roughly 25,000 genomes, finding evidence that this variant of the virus managed to outcompete its competitors. Those viruses that spread the fastest  are the most advantageous ones for the disease that seeks to endlessly replicate itself through infection, as compared to a virus that kills the host and in so doing kills its own chances of replication and reinfection of other people.

 

Registered nurse Candace Trammeor grabs shoe coverings inside the Coronavirus Unit at United Memorial Medical Center, Houston, Texas. (AP Photo)

Natural Beauty and Hygiene

"When the pandemic hit and we had forced shutdowns of hair salons, nail salons and medispas that used to be sort of routine for a lot of men and women, it caused us all to reflect on these aspects of our lives, these habits ... and think, is this really necessary? What am I doing this for? Am I doing this for perception of beauty? Am I doing this for self-care and relaxation?"

"This is when we let our hair colour grow out, our natural hair styles kind of come back. Same with our nails. ... The artificial nails from the salon come off and the nail polish wears off."

"We kind of get to see ourselves bare again."

Ivy Lee, dermatologist, Los Angeles

 

"People who haven't broken out with acne for a while are now paying more attention. [Many people now favour] cleaner, easier beauty regimens."

Anthony Rossi, dermatologist, Memorial Sloan Kettering Cancer Centre, New York Presbyterian Hospital

 

"In general, there's no medical hygienic benefit to really almost any of this [cosmetics, popular skin-care products]."

"For society, we like to smell a certain way and whenever you're adding additional chemicals, ingredients, there's more and more risk of getting contact dermatitis or allergies or even just irritant reactions."

Jules Lipoff, assistant professor, clinical dermatology, Perelman School of Medicine, University of Pennsylvania

 

"The longer nails are, the more likely they are to bang against things and get splits and breaks. Long nails can also harbour micro-organisms."

"We don't know about transmission of COVID through longer nails, but theoretically there are micro-organisms that can live under long nails."

Shari Lipner, associate professor of clinical dermatology, Weill Cornell Medical College, New York

ANGELA WEISS/AFP via Getty Images 

Experts have urged people to cancel nail and hair appointments to help curb the spread of the coronavirus.

Nail polish doesn't allow nails to breathe. The chemicals in nail polish may work their way beyond the nail into the skin tissues. Many nail polishes contain such chemicals as formaldehyde, toluene, dibutyl phthalate (DBP) and other plasticizers, along with camphor, ethyl tosylamide and triphenyl phosphate, some of which are carcinogens, others like camphor, if ingested, poisonous. How many people examine the list of ingredients -- if they can find them -- on these products?

Dr.Lipner points out that the removal process of popular gel nails can thin the nails through the process of abrasiveness, can cause them to split or break more readily. She also favours leaving the cuticles untouched, adding that: "The cuticles are there to protect your nails and your skin from invading microorganism", and with less reliance now on professional manicures and pedicures the cuticles are less likely to be cut.

With less access to hairdressing salons a boost has been given to the natural hair movement. People are less likely to return to professional stylists during the pandemic -- leading more people to give up dying their hair along with the use of other chemical treatments. The results have surprised people. Black women in particular are "seeing that their natural texture is stronger and healthier than it was when using the chemicals", says Tracie Radford, a hair and scalp specialist in Riverside, California.

Abandoning the use of hair relaxers and permanent waves and colouring dyes has turned out to be a  health plus for many people. During the pandemic, dermatologists and hair experts reported an increase in cases of telogen effluvium, a temporary, if distressing hair loss condition triggered by stress, shock or a traumatic event. Conditioning treatments and scalp detoxes (deep cleansing) is recommended by some specialists.

And then there's skin care for which cleaner, easier beauty regimens are considered an excellent replacement during these COVID days, with simpler routines. Three core concepts of skin care are  gentle cleansing, hydration and sun protection. Fewer cosmetics-related acne flare-ups are being reported by dermatologists in the new, global pandemic "less is more" attitude, eschewing makeup, dyes and polishes.

The Psychological Stress of Coping With COVID Avoidance

"Even in the 'average Joe', if you want to call them that, the pandemic has taken a really serious toll. Even for those without pre-existing mental disorders, half of them had major signs of depression and a third had signs of anxiety disorder. And those with pre-existing mental disorders, they're getting worse. And significantly worse. Anxiety is worse, depression is worse, suicidal ideations."

"It's a pretty concerning situation. What our results actually show is that regardless of where they started with a specific diagnosis, everyone seems to be getting worse in terms of their depression and anxiety. It affects nearly everyone."

Rebecca Robillard, director, clinical sleep research, The Royal Ottawa Mental Health Centre

"Treatment centres have had their capacity dramatically cut because of the need for physical distancing. Outpatient clinics have been reduced, capacity for withdrawal [treatment] has been reduced, and now even asking for help has become more problematic because there's a belief that there simply isn't any."

"I've had quite a few inquiries from people asking, 'Where do I go now?' And as much as the professional community has tried to address that, the message often doesn't get to the people who need the help."

Gord Garner, executive director, Community Addictions Peer Support Association

"This has really heightened my anxiety. Hunter [her son] is close to three years of sobriety, but I'm really watching to see that he's coping and managing, and that none of the red flags are going off."

"Luckily, most doctors have pivoted and gone virtual, so he's able to access his therapist and know that he's doing OK. But we see it at the centre; the anxiety is going through the roof."

Cindy Manor, senior director of philanthropy, Dave Smith Youth Treatment Centre

  

Matthew Young, senior research and policy analyst, Canadian Centre on Substance Use and Addiction

Since the SARS-CoV-2 virus roared onto the world stage and was soon declared a global pandemic public messages of self-isolation, mask-wearing, personal hygiene, no-touch surfaces and hand-washing have all conspired to create a fearful and troubled public, one unaccustomed to socially isolating and for whom the go-it-alone self-protection against a sometimes-deadly disease has extracted a heavy price in confidence and mood. The result has been a predictable rise in depression and anxiety.

Those conditions have been exacerbated in people already struggling with mental health issues, but those in the general public who had never previously been troubled with isolating depression and heightened anxiety have also felt its grievous numbing effect. Research carried out at the Royal Ottawa Mental Health Centre has underscored those issues. Dr.Robillard, who spearheaded the recently published study based her research on an online survey of six thousand Canadians.

The survey is incomplete in the sense that it covered the period between April 3 and June 23, quite early in the pandemic. Questions posed to survey respondents saw the youngest participant at age 16 and the oldest 99 years of age. The rise in anxiety and depression was largely spurred by fear of contracting COVID-19, but respondents feared as well becoming more ill from existing illnesses as a result of cancelled or delayed medical appointments.

Lost income resulting from the economic lockdown, along with troublesome family and personal relationships also played into the heightened anxiety. The pandemic resulted in fewer appointments for people in treatment for mental issues, with their doctors or counsellors. Online counselling eventually up and in operation filled the gap to a certain degree, almost reflecting the effectiveness of previous face-to-face interactions.

Dr.Robillard assessed alcohol and cannabis use, finding it increased by up to 15 percent, but on the other hand, some respondents reported declining personal use, so "it's a bit of a mixed bag", she declared. While COVID spares none, young or old, healthy or health-impaired, wealthy or struggling to get by, women and younger people in particular appear to be most affected. Dr.Robillard points out that younger women mostly deal with child care stress during the pandemic, while young people are most likely to be stressed over front-line workplaces, dealing with the public.

"And we know that sometimes the general public isn't very compliant with social distancing measures. Also, even though you're working, you may not be sure you'll be working next month or that you'll have the hours you need to support yourself." Some of the participants in the study agreed to remain with the research longer term, to determine how their mental health would be impacted over time. 

 

Because of the time line of the study, the second wave of infections wasn't included. What was clear, however, was that more resources will be required to handle mental health needs as the pandemic progresses.

"As time goes along, we're seeing some decrease in the anxiety level. People are starting to get a tiny bit less anxious because they're starting to adapt to the situation, it's a bit less of a shock. But for a lot of people, that is still a prolonged period of anxiety and stress, and in the longer term, it can sustain some degree of depression. While anxiety was going down, the depression is going up", Dr.Robillard pointed out.

A woman wearing a mask talks on her phone during the COVID-19 pandemic in Toronto. THE CANADIAN PRESS/Nathan Denette

A Year 2020 'Twindemic'

Flu vaccine   Postmedia

"Having two circulating respiratory viruses is not a good thing. This is something we can do something about. From a societal perspective, we have to reduce the pressure on our health-care system."

"Everyone should get the flu vaccine this year. It's a no-brainer." 

"We don't want people congregating as they usually do in gymnasium-type programs. We need to do it differently. And well."

"...If you could reduce your risk, why wouldn't you do it? Even in a worst-case scenario [difficulty in matching vaccines with current flu strain, resulting in reduced effectiveness], it's still worth it."

Dr.Kumanan Wilson, scientist, Ottawa Hospital Research Institute

"Most health-care workers would say we're barely managing in a normal flu season. We're always on the verge of collapse. If you add COVID, we're in big trouble."

"The biggest problem with how we view influenza is that there are other respiratory viruses circulating. The flu is a whole bunch of viruses with a whole bunch of different presentations. They're impossible to distinguish without lab tests."

"If people keep having parties, we'll have influenza. But if you can control COVID, you can control influenza."

Dr.Jeff Kwong, epidemiologist, professor, Dalla Lana School of Public Health, University of Toronto

(HealthDay)—Fall is approaching, and so is the possibility of what public health officials are calling a "twindemic"—overlapping epidemics of both COVID-19 and influenza

"We're expecting increased demand. People are already making reservations [for flu shots delivered by pharmacists]."

"If there is one thing you can control this year, it's the flu shot. It's going to be a busy year."

Sheilita Dattani, director, professional affairs, Canadian Pharmacists Association

"[If you protect children, you are protecting everyone around them]. I'm hoping for a milder flu season, but you can't trust luck."

"We need to tell parents to roll up their sleeves ... and the sleeves of their children."

Dr.Ran Goldman, researcher, professor of pediatrics, University of British Columbia

This year's flu shot, according to infectious diseases experts, is crucial to avoid the potential of the northern hemisphere facing the perfect storm in the convergence of COVID-19 with its predecessor, the seasonal flu. Health care systems currently strained to cope with increased calls on their vital services are set to be endangered by the possibility of having to face and begin caring for a double surge in cases; COVID and flu. People who feel they have already been through the wringer in COVID infection avoidance, only just beginning to return to a wan semblance of normalcy will be facing a backtrack.

Having to remove oneself from the workplace because of any type of respiratory symptoms will set people, their workplaces and their communities back to square one. According to the Public Health Agency of Canada, an average of 12,200 hospitalizations and 3,500 deaths related to the flu take place annually. In 2019-2020, 42,541 cases of seasonal influenza surfaced based on laboratory testing. Leading to medical community concerns over the potential of the coming winter season presenting with a clash of COVID and influenza cases striking simultaneously.

Should people -- fed up with compliance over basic steps to avoid infection -- relax on the infection-protective wearing of masks, on physical distancing and hand hygiene, the likelihood of a 'twindemic' looms ahead in the near future. The rare potential to be afflicted with both flu and COVID is quite possible. The Journal of Medical Virology published a paper finding that among 1,103 patients diagnosed with COVID-19 in three hospitals in Istanbul, Turkey, six patients were diagnosed as infected with influenza as well.

THE CANADIAN PRESS/Darryl Dyck

Lest that be dismissed as a one-time quirk, co-infections have been reported in patients out of China, Germany, Iran, Japan, Spain and the United States. In Canada, disturbing reports have surfaced through Health Canada of a shortage of personal protection equipment for staff who are themselves a problem in diminishing availability. In the same token an anticipated increased take-up of flu inoculations will most certainly create a bottleneck situation that must be solved before it becomes reality.

To that end other possibilities are being bruited about by Health Canada such as the use of drive-thru and parking lot clinics, where car washes, arenas, insurance inspection centres and drive-thru tents may become additional venues useful to dispense vaccinations. Pharmacists have in the past been relied upon to administer between 40 and 50 percent of flu shots in Canada, and plans are that they be enlisted to continue in that vein and even increase such services.

The possibility of delivering flu shots by appointment, through dedicated hours for walk-in clinics, special hours for vulnerable patients, off-site services such as home visits and clinics established at community halls or temporary structures are all under consideration. In Australia, a report released on September 6 noted 21,119 cases of laboratory-confirmed influenza and 36 laboratory-confirmed deaths attributed to flu; a lower-than-average count for this time of year. A possible harbinger elsewhere for the coming winter season.

 (THE CANADIAN PRESS / AP / Toby Talbot)

The Journal of Pediatrics published a study of close to 3,000 families, finding that a greater number of parents planned to vaccinate their children this flu season. Researchers interviewed parents who visited 17 emergency departments in Canada, Israel, Japan, Spain, Switzerland and the U.S. of their wish to vaccinate their children and roughly 54 percent responded they would be willing to do so. Those who failed to vaccinate children last year saw 29 percent planning to this year.

Even that the flu shot is not robustly effective since public health authorities must make an educated guess about which strain will be circulating in any given year, thus it becomes difficult to assess vaccine match and effectiveness, the resulting vaccine is still credited with functionality. The flu strain circulating in November, as an example, may not be the same strain in March. "But if you could reduce your risk, why wouldn't you do it? Even in a worst-case scenario it's still worth it", urges Dr.Wilson.